What is Orthostatic Hypotension?
Your body has a network of blood vessels made up of arteries, veins, and capillaries. The heart pumps blood into the arteries, which carry the blood throughout the body. Blood pressure is the pressure or force of blood pushing against the walls of the arteries.
Blood pressure is written as two numbers; for example, 120 over 80 millimeters of mercury. The first number is the systolic pressure. This is the pressure in the arteries when the heart beats and fills them with blood. The second number is the diastolic pressure. This is the pressure in the arteries when the heart rests between beats.
Orthostatic hypotension is a condition in which your blood pressure falls significantly when you stand up quickly. (Hypotension is low blood pressure.)
What are the causes of orthostatic hypotension?
The causes of orthostatic hypotension include the following:
- Aging (orthostatic hypotension is more common in older people)
- Hypovolemia (a drop in the volume of blood) and dehydration (low fluid volume in the body). Common causes of these are bleeding, elevated sugar, diarrhea, vomiting, and medications like thiazide diuretics (HCTZ) and loop diuretics (furosemide, bumetanide)
- Dehydration (low fluid volume in the body)
- Immobility (for instance, staying in bed for a long time)
- Heart conditions, including heart attack, heart failure, irregular heart rhythm, and valve disease
- Anemia (low red blood cell count)
- Parkinson's disease
- Diseases of the endocrine system, including diabetes, adrenal insufficiency, and thyroid conditions
- Medications that are used to treat elevated blood pressure, such as beta blockers, calcium channel blockers, ACE inhibitors, nitrates, and angiotensin II blockers. Patients who are at risk for this are those with conditions listed above (for example, diabetes, Parkinson’s)
- Other medications for anxiety, depression, erectile dysfunction, or Parkinson's disease
- Substances that are taken at the same time as blood pressure medications, such as alcohol, barbiturates, and other medications
- Hot weather
What are the symptoms of orthostatic hypotension?
The main symptom of orthostatic hypotension is feeling dizzy or lightheaded when you stand up. In some cases, people with orthostatic hypotension may even faint.
Other symptoms include:
- Blurred vision
- Disorientation or confusion
- Feeling weak
- Chest pain
These symptoms usually clear up when you sit or lie down for a few minutes.
Diagnosis and Tests
How is orthostatic hypotension diagnosed?
If your doctor thinks you may have orthostatic hypotension, he or she will check your blood pressure while you are lying down, sitting, and upright. The doctor will also perform a physical examination in order to find a medical condition that may be causing the hypotension.
The doctor may also order certain tests, including the following:
- Blood test (to check for anemia or diabetes)
- Electrocardiogram, or EKG (to check your heart's rhythm)
- Holter monitor (a portable device that you wear to check your heart's rhythm over a period of time)
- Echocardiogram (ultrasound examination of the heart)
- Stress test, in which the doctor monitors your heart rate while you are exercising
- Valsalva maneuver, in which you take several deep breaths while your doctor checks your blood pressure and heart rate
- Tilt table test. You might have this test if you are prone to fainting. You lie on a table that is moved from a horizontal to an upright position. Your doctor will want to know if you faint during this test.
Management and Treatment
How is orthostatic hypotension treated?
If you have episodes of orthostatic hypotension, your doctor will first try to determine if you have another condition or disease that is causing it. In many cases, treating the disease that is causing the orthostatic hypotension will cure it.
If a certain medication is causing the orthostatic hypotension, your doctor may adjust the dosage or switch you to another medication.
One method of treating orthostatic hypotension is to make some changes in your daily life. These can include the following:
- If you are dehydrated, drink more fluids.
- Limit or avoid alcohol (alcohol causes dehydration).
- Stand up slowly when getting out of a chair.
- Don't cross your legs when you are sitting.
- If you have to stay in bed for medical reasons, try sitting up for short periods of time.
- When you are getting out of bed, get up slowly and sit on the edge of your bed for several minutes before you stand up.
- You may perform isometric exercises (such as squeezing a rubber ball or a towel for a few minutes) before assuming an upright position. These exercises will raise your blood pressure and may prevent a significant drop in blood pressure when you stand up.
- You can wear compression stockings, which apply pressure to your legs and help with blood circulation.
- Raise the head of your bed.
- Don’t stand for long periods of time.
Your doctor may prescribe a medication to treat the orthostatic hypotension, such as fludrocortisone (Florinef®), midodrine (ProAmatine®), or erythropoietin (Epogen®, Procrit®). These drugs work by increasing blood volume or by constricting (narrowing) blood vessels.
Outlook / Prognosis
What is the outlook for people with orthostatic hypotension?
Orthostatic hypotension can be treated successfully. If you have episodes of this condition, you can seek treatment and live a normal life.
- American Family Physician. Evaluation and Management of Orthostatic Hypotension Accessed 11/23/2016.
- Parkinson’s Disease Foundation. Orthostatic Hypotension (Low Blood Pressure). Accessed 11/23/2016.
- Figueroa JJ, Basford JR, Low PA. Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleve Clin J Med. 2010;77(5):298-306.
© Copyright 1995-2019 The Cleveland Clinic Foundation. All rights reserved.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.
This document was last reviewed on: 07/16/2019